NHS news review:

Speculation concerning the future of the Destroy the NHS bill and the coalition government.

The King’s Fund response to the Destroy the NHS Bill proposes greater intergation and collaboration to improve services.

Further health funding cuts in Manchester.

Waiting times rise.

NHS Central Lancashire is considering making GPs redundant.

Lansley admits that the NHS Bill may be delayed by further scrutiny by MPs.

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Will the Liberal Democrats really save the NHS? » Hospital Dr

The Lib Dems have a lot to answer for when it comes to the deeply unpopular Health and Social Care Bill. The Orange Book wing of the Lib Dems, of which Nick Clegg is a key member, actually supports the idea of a social insurance scheme with private providers to replace the NHS, which is a key objective of the current bill.

The Lib Dem election manifesto promoted the idea of a market-based healthcare system and abolition of SHAs. The coalition agreement on health reform was signed by Nick Clegg and reviewed by Danny Alexander. The final page of the Bill itself (p367) has the Lib Dem names of Nick Clegg, Vince Cable, Danny Alexander and Paul Burstow as supporters the Bill.

Finally, Lib Dem MPs have fully supported the Bill through its first two readings in Parliament.

However, the political landscape changed when the scale of the public and professional opposition became clear. The Lib Dem’s Spring conference, along with other factors such as the Royal College of Nursing vote of no confidence in health secretary Andrew Lansley, was crucial in terms of changing Nick Clegg’s stance on the reforms and gaining a natural “pause” in the Bill.

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Major changes to health reforms needed to deliver ‘new model’ of care says The King’s Fund – The King’s Fund

The King’s Fund has called for significant changes to the government’s health reforms to enable the NHS to provide a ‘new model’ of care that meets the challenges of the future.

In its response to the government’s listening exercise on the Health and Social Care Bill, the Fund says it supports the need for reform but argues that it must be based on a clear diagnosis of NHS performance and the challenges it faces. It calls for the NHS to be re-orientated to deliver a new model of ‘integrated’ care, based on stronger collaboration between health professionals and more effective co-ordination of services.

The response argues that integrated care offers the best prospect of improving services for patients and addressing the key challenge facing the NHS – demographic change and the increasing number of people with long-term conditions such as diabetes, asthma and dementia. It draws on evidence from the NHS and the United States showing that integrated care delivers better outcomes for patients with long-term conditions and improves the quality of specialist services such as cardiac, cancer and stroke care.

The Fund calls for a number of significant changes to the Health and Social Care Bill and wider health policy to deliver integrated care.

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“NHS is under-managed but over-administered” » Hospital Dr

The NHS is under-managed but over-administered, a report from the King’s Fund finds.

It calls for a new style of leadership to overcome unprecedented financial pressures and adapt to future challenges.

High-quality, stable management is be key to high-performing health services, it finds. Yet across the NHS, the average chief executive spends just 700 days in post. In part, this reflects a culture where ‘heroic’ leaders grapple with problems only from the top of the organisation, or are ‘parachuted in’ to replace individual managers and ‘turn around’ troubled NHS services. The report advocates a new type of ‘shared leadership’ involving leaders at different levels of the workforce working collaboratively with all those involved in patient care to lead change and improve services, rather than only tackling problems inside specific institutions.

The report criticises the government for not assessing the future needs of the NHS before imposing a 45% cut in NHS management posts and 33% cut in administration costs.

It says: “There is no persuasive evidence that the NHS is over-managed, and a good deal of evidence that it may be under-managed. While administration and management costs will have to take at least their fair share of the pain as real-terms growth in NHS spending ceases, a more sophisticated approach to the reduction in both is needed.”

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Health chiefs in new bid to save another £20m | Manchester Evening News – menmedia.co.uk

Health chiefs say they will have to save more than £20m from Manchester’s NHS budget this year. It comes after £30m in cuts in spending last year.

NHS Manchester is now drawing up plans including slashing management costs by £3.7m and cutting £2m by rationing treatment.

A new system for GPs’ referrals is being credited with helping make savings last year.

All treatment apart from mental health, obstetrics and urgent care, now has to go through a ‘referral gateway’ before being approved.

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Pulse – Waiting times on the rise

The number of patients waiting more than 18 weeks from referral to treatment is greater than at any time since mid-2008, the latest NHS statistics for England reveal.

More than 35,000 patients waited more than 18 weeks for treatment in March, breaking the NHS constitution-enshrined right for 18 week waits for the second month running.

The figures show that 10.4% of patients waited for more than 18 weeks from referral to treatment in March, up from 10.2% in February.

The numbers of patients waiting for more than 18 weeks has increased steadily since ministers removed the formal target of admitting 90% of patients within 18-weeks last summer. The target had been strictly enforced until last June but still remains a patient right under the NHS Constitution.

Figures for non-admitted patients showed the numbers being treated within 18 weeks had stayed stable on around 97% since the beginning of the year. Some 25,578 non-admitted patients waited for longer than 18 weeks in March.

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Pulse – GPs to be made redundant as managers cut costs

Exclusive: Salaried GPs employed by a PCT face being made redundant as NHS managers charged with cutting costs turn their attention to general practice.

NHS Central Lancashire has placed a series of salaried GP positions under review as the PCT looks to restructure the organisation and realign costs.

Dr Edoardo Cervoni, a full-time permanent salaried GP employed by the PCT to work in practices in Preston and Ormskirk, is one of several GPs to be told their contracts are due to be terminated by the trust.

Dr Cervoni was informed in April that salaried GP positions had been placed under review and has now been told to expect to be made redundant at the end of July.

‘I was told that the PCT was going to stop providing clinical services and it had been planned that salaried GP positions “had to go”,’ said Dr Cervoni, a GP specialist in ENT medicine with 17 years’ experience.

‘Being made redundant is not nice and it has a negative impact on your career and particularly on your family life. I hope I may remain one of the very few GPs to have to experience the feeling, but it really seems that the process of dismantling the NHS is well on the go.’

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NHS bill may need fresh scrutiny from MPs after ‘listening exercise’ | Society | The Guardian

The changes to the government’s flagship NHS bill could be so substantial that it has to undergo fresh scrutiny by MPs – delaying its passage through the Commons, the health secretary said on Monday.

The bill has already passed through the committee stage, where it was scrutinised line by line by MPs, but the proposals have been paused for a “listening exercise” with NHS staff and the public. A panel of experts, known as the Future Forum, was tasked with hearing concerns about the bill – a process that ends next week.

In an online question and answer session with Guardian readers, the health secretary, Andrew Lansley, answered a post about “recommitting” the bill to the house. “We won’t decide that until we have received the NHS Future Forum report and have responded to that. I told the House of Commons on 4 April that we would ensure proper scrutiny of the bill – we have done that so far and we will continue to do so,” he wrote.

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NHS news review:

A protest by doctors in York.

HospitalDr reports on the actually widely known outsourcing of NHS treatment under Labour to reduce waiting lists. Private companies were paid regardless of whether they actually did the operations.

Cuts to Diabetic Specialist Nurses adversely affects treatment of Diabetes.

Staff cuts at Epsom General Hospital.

A claim that coalition conflict is damaging the NHS.

Guardian Comment is Free praises Nick Clegg. I suggest that it is important to realise that Clegg is not outright opposing competition in the NHS or the issue that the Health Secretary should provide a comprehensive healthcare system. Clegg has until recently been a wholehearted supporter of this bill. We could do with a fact check as to whether Clegg & Co are complying with the resolution of their Spring Conference. I suspect that they are not. Interesting comments to this article.

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Health cuts protesters march through York streets (From York Press)

A MARCH organised by York doctors concerned about NHS reforms took place in the city centre at the weekend.

About 150 people worried about the scale of the Government’s NHS changes attended the protests, organised by Defend Our NHS York.

The march made its way to Parliament Street where the speakers included Baroness Haleh Ashar, a member of the House of Lords and professor of politics and women’s studies.

Protesters were joined by shoppers and tourists when speeches were made by the fountain in Parliament Street followed a chorus of “three cheers for the NHS” led by Dr James Chan.

Speaking to the crowd, Dr Chan, who is based at York Hospital, said: “We are here to stop these cuts because they are going to destroy the NHS.

“This is York’s voice against these reforms, which are the wrong plan at the wrong time, and you are all NHS heroes.”

Baroness Afshar said “There are times when the public knows best, and this is one of those times.

“These reforms make no sense and what we want is more transparency.

“I don’t know any GP who supports these reforms because they do not have the expertise and they do not have the information.

“It is nonsense from beginning to end, so I urge you to please, please protect our NHS.”

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£500m wasted in private treatment centres for NHS » Hospital Dr

Private firms were paid millions for operations that never took place in overly generous contracts drawn up by the Department of Health, in a Labour plan to cut waiting times and improve choice.

The independent providers – ISTCs – received more cash for their buildings when contracts came to an end, and were even paid compensation when a second wave of clinics was cut back, a study by the Bureau of Investigative Journalism has found.

Another part of the £1.5billion scheme intended to allow busy workers to see doctors near offices – or polyclinics as they became known – but the new walk-in centres were under-used and most are closing down.

As controversial reforms to the NHS will provide even greater opportunities for private providers, it is feared that more public money will be wasted on similar projects to the doomed Independent Sector Treatment Centre initiative.

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Diabetics are put at risk as NHS cuts hit specialist nursing posts | Society | The Observer

The number of diabetic specialist nurse (DSN) posts unfilled across the service has doubled within a year. A survey of 385 hospital trusts and primary care trusts (PCTs) by Diabetes UK found that 218 jobs were vacant last year, even though the number of people with diabetes is rising by 150,000 a year.

“At a time when numbers of people with diabetes are increasing, a decrease in the number of diabetes specialist nurses is very concerning,” said the charity’s chief executive, Barbara Young. “This will mean longer waiting times for specialist support, more unnecessary amputations, more people losing their sight and far poorer health outcomes. This is simply not acceptable.”

The research also reveals that the proportion of DSN posts lying unfilled because of cost-saving programmes had risen to 43% – up from 34% in 2009. PCTs and hospitals in England have increasingly been reducing their staff and cutting back on the services they provide as they struggle with the demands of a £20bn NHS efficiency drive, flat budgets and rising costs. The new findings confirm a growing tendency among bosses of cash-strapped NHS organisations not to replace specialist nurses – who also help patients with cancer, multiple sclerosis, Parkinson’s disease and other conditions – when they retire, move on or are made redundant. However, these nurses are popular with patients and their families, have a proven record of clinical success and an ability to save the NHS money by helping patients stay at home rather than in hospital.

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BBC News – Epsom and St Helier NHS savings put 115 jobs at risk

An NHS trust with hospitals in Surrey and London has set out savings plans that could see the loss of 115 posts including 26 doctors.

Epsom and St Helier University Hospitals NHS Trust has begun a 90-day consultation with staff and unions.

The trust said it wanted to save £18.7m by March 2012 but it would still be left with a £19.3m deficit at the end of the financial year.

The public sector Unison has not yet commented on the savings plans.

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Coalition must resolve divisions over NHS, says King’s Fund | Society | The Guardian

David Cameron and Nick Clegg have been told to end their public “arm-wrestling” over the NHS because their divisions are worrying health professionals.

They should resolve the coalition’s deepening difficulties on the issue and make the service’s future clear as soon as possible.

The sharply-worded intervention in the increasingly fractious debate between the Conservatives and Liberal Democrats comes from Prof Chris Ham, chief executive of the King’s Fund health thinktank and a member of Downing Street’s “kitchen cabinet” on health policy.

“These arguments between the political leaders are worrying and unsettling people in the NHS. If you are running a hospital or primary care trust or pathfinder consortium of GPs you are now very unclear about the direction that the government is going in on these reforms,” Ham said.

“Everything is back in the melting-pot. We are worried about the adverse effects on the NHS if this current uncertainty continues much longer.”

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NHS shakeup: From malignant to muddled | Comment is free | The Guardian

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Nick Clegg is making a real difference. These are not common words to read these days, and yet they are becoming hard to dispute with the stalled English health reforms. It is true that the deputy prime minister would be better placed to claim credit if he had not initially nodded Andrew Lansley’s bill through, and true, too, that not all the sweeping concessions he now demands fit with the scepticism about the NHS he has sometimes shown in the past. Nonetheless, Mr Clegg has responded decisively to his party’s democratic will, and is training his sights on the heart of the Lansley plans.

First, he drew a red line around the crucial clause that tasks the regulator with “promoting competition”, and he has now done the same with the legislative invitation for “any qualified provider” to take on the NHS. The deputy PM must now apply a third veto to the unacceptable plan to allow private firms to discharge the core public function of spending health service money. He will then have removed the three greatest drivers of privatisation from among the 80-odd clauses that create an NHS market. Assuming, of course, that he can strong-arm the Conservatives into agreeing. He can afford no compromise. Savaged in Scotland, ravaged in the referendum and trashed in town halls, Mr Clegg retains a grip over his parliamentary party that surprises many outsiders. To keep it, however, he simply has to win this fight.

One reason to be optimistic is that the tide of opinion seems to have decisively turned. Marketising medicine had been steadily becoming entrenched as the orthodoxy, ever since Tony Blair made it his millennial mission. The bust-up over the bill, however, has made the whole approach controversial again. Suddenly Labour’s John Healey, who spent a lonely autumn developing all the criticisms of the Lansley blueprint that medics and Lib Dems now voice with such passion, concedes that his own party wrongly pursued “competition for its own sake” through overpriced and underutilised private treatment centres.

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NHS news:

Nick Clegg has split from his coalition partners on the role of the health regulator, Monitor.

Clegg also seems to be having a dig at his coalition partners:”People get confused when one day they hear politicians declare how much they love the NHS and the next they hear people describing themselves as government advisers saying that reform is a huge opportunity for big profits for health care corporations.”

Chartered Society of Physiotherapy Chief Executive Phil Gray claims that the destroy the NHS bill always intended to turn the NHS into a state insurance provider.

Cameron distances himself from his adviser Mark Britnell after remarks about turning the NHS into a “state insurance provider, not a state deliverer” of care.

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Clegg: NHS regulator must work on co-operation not competition | News

Nick Clegg today demanded a concession in the NHS reforms by saying that an official regulator should promote co-operation rather than competition between health providers.

The Deputy Prime Minister’s intervention piqued some supporters of Health Secretary Andrew Lansley, who said his plans had always been focused on “quality” rather than price.

He also criticised David Cameron at a private meeting of Liberal Democrat MPs for declaring his “love for the NHS” while taking advice from people talking up the potential for private profits. Mr Cameron was said to be relaxed at the comments made by his Liberal Democrat deputy.

Mr Lansley appeared willing to give ground for the sake of the Coalition, saying: “This is not Henry V on St Crispin’s Day – a one man on horseback approach.” Under the NHS plans, the independent regulator will get a new role as an “economic regulator”. Mr Clegg said there should be a duty to promote collaboration, which might ease pressure on struggling units.

He also said: “People get confused when one day they hear politicians declare how much they love the NHS and the next they hear people describing themselves as government advisers saying that reform is a huge opportunity for big profits for health care corporations.”

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Nick Clegg: NHS regulation re-think just the beginning – Channel 4 News

Nick Clegg is expected to propose further amendments to the Health Bill over the next few weeks as he attempts to appease his party over the scale and pace of the reforms, writes Victoria Macdonald.

On Tuesday night, the Deputy Prime Minister presented a page-long document to the weekly meeting of his parliamentary party in which he singled out the role of Monitor, the NHS regulator, as the area of the Bill needing the most substantial change.

The document, which was later leaked, suggests removing all references to Monitor being an economic regulator.

“Instead of having a duty to promote competition, Monitor’s main duty should be explicitly to protect and promote the interests of patients,” Nick Clegg wrote.

He said the decision to establish it as an economic regulator was clearly a misjudgment and that the NHS could not be treated as if it were just a utility “like electricity or telephones”.

But his party has tabled more than 21 substantial amendments to the Bill and while Mr Clegg has picked out one of the key elements, which goes to the heart of the legislation, Lib Dem insiders say they expect him to deal with issues such as accountability of the commissioning boards, and conflicts of interest where GPs buying care for patients also have financial interests in companies providing treatments.

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Threat to NHS made clear | The Chartered Society of Physiotherapy

CSP chief executive Phil Gray argues that the government’s NHS reform plans always intended to turn the NHS into a state insurance provider, not a state deliverer.

Writing in a letter to the Guardian, published today, Mr Gray says health secretary Andrew Lansley made clear his objectives in his white paper and the subsequent Health and Social Care Bill.

Mr Gray was writing in response to David Cameron’s speech on Monday, setting out the case for the NHS reforms.

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David Cameron ‘had never heard’ of adviser who warned on NHS reforms | Politics | guardian.co.uk

David Cameron has distanced himself from Mark Britnell, a member of the “kitchen cabinet” advising him on health, after he said the government’s reforms would transform the NHS into a “state insurance provider, not a state deliverer” of care.

Cameron said he had never heard of Britnell before the weekend, despite the fact that the adviser – the head of health at accountancy giant KPMG – was invited to join a group of senior health policy experts in Downing Street earlier this month. The “kitchen cabinet”, which includes former NHS executives and the former Department of Health permanent secretary Lord Crisp, was assembled by Cameron’s special adviser on health, Paul Bate.

“He [Britnell] is not my adviser,” Cameron told MPs, insisting he had “never heard about this person in my life” before it emerged on Sunday that Britnell told a conference of executives from the private sector last year that future reforms would show “no mercy” to the NHS.

Britnell also told the conference, held in New York, that the reforms would offer a “big opportunity” to the for-profit sector and suggested the NHS could be improved by charging patients.

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